Provider Demographics
NPI:1720690522
Name:GAYDEN, TELICIA BERNICE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TELICIA
Middle Name:BERNICE
Last Name:GAYDEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-3930
Mailing Address - Country:US
Mailing Address - Phone:601-693-5302
Mailing Address - Fax:601-693-5360
Practice Address - Street 1:1415 24TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-3930
Practice Address - Country:US
Practice Address - Phone:601-693-5302
Practice Address - Fax:601-693-5360
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-15633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist